Yes, there are several medications that can help you stop drinking or cut back significantly. Three are approved by the FDA specifically for alcohol use disorder, and two more are recommended as second-line options by the American Psychiatric Association. These medications work in different ways: some reduce cravings, some block the rewarding effects of alcohol, and one makes you feel physically ill if you drink. Despite strong evidence behind them, they remain underused, partly because many people simply don’t know they exist.
The Three FDA-Approved Options
The three medications with full FDA approval for alcohol use disorder are naltrexone, acamprosate, and disulfiram. Each targets a different part of the cycle that keeps people drinking, so the best choice depends on your situation, your goals, and your medical history.
Naltrexone
Naltrexone works by blocking the brain’s opioid receptors, which are involved in the pleasurable “buzz” you get from alcohol. When those receptors are blocked, drinking feels less rewarding, and cravings triggered by situations or environments associated with alcohol become weaker. It comes in two forms: a daily pill and a monthly injection (sold as Vivitrol), which has been available since 2006. In clinical trials, naltrexone reduced the likelihood of returning to heavy drinking with a number needed to treat of 11, meaning for every 11 people who take it, one additional person avoids relapsing to heavy drinking compared to placebo. That’s a meaningful effect, roughly on par with many widely prescribed medications for other conditions.
Acamprosate
Acamprosate works differently. It helps calm the brain’s signaling systems that become overactive after you stop drinking. Chronic alcohol use disrupts the balance between excitatory and inhibitory brain activity, and when you quit, the excitatory side goes into overdrive, producing anxiety, restlessness, and persistent cravings. Acamprosate helps restore that balance. It’s most effective in people who have already stopped drinking and want to stay abstinent. Its number needed to treat is 11 for preventing a return to any drinking at all. One practical advantage: it’s processed by the kidneys rather than the liver, making it a better choice for people with liver damage from heavy drinking.
Disulfiram
Disulfiram, the oldest of the three (often known by the brand name Antabuse), takes a completely different approach. It doesn’t reduce cravings. Instead, it blocks an enzyme your body uses to break down alcohol. If you drink while taking it, a toxic byproduct called acetaldehyde builds up in your bloodstream, causing flushing, sweating, headache, nausea, vomiting, rapid heartbeat, and confusion. The experience is unpleasant enough to act as a powerful deterrent. Disulfiram works best for people who are motivated to stay abstinent and want a built-in consequence to reinforce that commitment. Common side effects even without drinking include a metallic or garlic-like taste in the mouth, mild headache, drowsiness, and occasional nausea. It’s not recommended for people with advanced liver disease.
Second-Line Medications
The American Psychiatric Association suggests topiramate or gabapentin for people who haven’t responded to the FDA-approved options or who prefer an alternative. Topiramate is particularly useful when someone has a co-occurring condition it can also treat, such as a seizure disorder. These medications are prescribed “off-label” for alcohol use disorder, meaning they were originally developed for other conditions but have enough clinical evidence to be recommended by professional guidelines. Your prescriber can help determine whether one of these makes sense for your situation.
How Naltrexone Is Used Differently
Most medications for alcohol use disorder are prescribed as a daily pill taken continuously. But naltrexone has an alternative approach sometimes called targeted use or the Sinclair Method. Instead of taking naltrexone every day, you take it only before situations where you expect to drink or feel strong cravings. The idea is rooted in a specific mechanism: if naltrexone blocks the rewarding effects of alcohol, then drinking while on naltrexone gradually trains your brain to stop associating alcohol with pleasure. Over time, this can reduce the drive to drink.
Research on this approach found something notable. Naltrexone worked significantly better when paired with therapy that allowed for some drinking rather than demanding total abstinence. In studies where patients were told they must never drink, naltrexone performed no better than a placebo. When patients were allowed to drink but given coping strategies, naltrexone produced meaningful reductions in consumption. This suggests the medication’s benefit depends partly on the behavioral framework surrounding it.
What to Expect Before Starting
Getting a prescription is straightforward. Any physician or nurse practitioner can prescribe these medications; you don’t need to see an addiction specialist, though one can help. Before starting, your provider will likely check your liver function through a blood test, especially if naltrexone or disulfiram is being considered, since both are processed by the liver. If you take opioid medications for pain, naltrexone is off the table because it blocks opioid receptors and would interfere with pain relief (and could trigger withdrawal if opioids are in your system). In that case, acamprosate or topiramate would be the go-to alternatives.
You don’t need to be completely sober before your first appointment. Acamprosate works best if you’ve already stopped drinking, but naltrexone can be started while you’re still drinking in some cases. Your provider will tailor the approach to where you are right now.
How Long Treatment Lasts
The Substance Abuse and Mental Health Services Administration recommends staying on medication for at least 6 to 12 months. This isn’t arbitrary. A significant proportion of people relapse within the first year after starting treatment, and longer medication use is associated with better outcomes. In one study of over 9,000 patients with both alcohol use disorder and liver cirrhosis, those who stayed on acamprosate or naltrexone for 3 to 12 months had a 27% lower risk of death compared to those who received no medication. Patients treated for less than 3 months saw a smaller benefit.
The American Psychiatric Association recommends individualizing the timeline based on factors like how severe the disorder is, your history of relapse, how well you tolerate the medication, and what the consequences of relapse would be. For many people, staying on medication for a full year or longer is the most protective approach. Outcomes consistently improve with treatment durations beyond 3 months.
Medication Works Better With Support
These medications are most effective as part of a broader plan. That might include cognitive behavioral therapy, motivational interviewing, peer support groups, or structured outpatient programs. The research is clear that combining medication with some form of psychosocial support produces better results than either one alone. Naltrexone’s effectiveness, in particular, depends heavily on the therapeutic approach it’s paired with.
None of these medications are a cure, and none eliminate the effort involved in changing your relationship with alcohol. What they do is shift the odds meaningfully in your favor by quieting cravings, reducing the reward of drinking, or creating a concrete consequence for picking up a drink. For many people, that’s the difference between knowing they want to stop and actually being able to.